reflections – Page 20 – Go Retire Psychiatrist

Eyes of a Child

Sena wonders if I’m ever going to use Patsy Cline’s tune “If I Could See the World (Through the Eyes of a Child) in a blog post. She also brought home a potted plant she bought, an Easter Lily, ahead of Easter Sunday on April 9th next week. I thought of a couple of things, and of course one is a quote from Men in Black 3:

Agent O: “Agent K is dead!”

Agent J: “Well, I just talked to him last night!”

Agent O: “You are imagining things.”

Agent J: “I’m not imagining anything. Aqua Velva after shave! I didn’t imagine that. Where every stakeout, endless hours of cowboy music.”

Agent J and I have a few things in common. One of them is a mild dislike for country western (cowboy by extension) music. I can’t help it OK; the Patsy Cline tune is one of those.

I’m the first to admit I’m not a Bible scholar, but I’m going to talk a little bit about the apparent contradictions between being childish and childlike in the Bible. The reason is that the lyrics in “If I Could See the World” is either an obvious or accidental reference to the seeming contradiction between being like a child in one sense and in another sense, growing up and putting away childish things.

There’s no contradiction if you remember the scripture quotes are in different contexts. In childhood, we’re innocent, trusting, and open. Being open to the kingdom of heaven is the context for that. On the other hand, another context is when we grow up and recognize the duplicity in other people and the inevitable push to learn how to lie. If you don’t tell Aunt Clara that you love her gift of fruitcake at Christmas, you will be grounded for a week.

OK, so that’s the extent of my Bible scholarship.

I’m not a credible music critic either. But it’s easy to see the connection of the Patsy Cline song “If I Could See the World (Through the Eyes of a Child) to the book of Matthew. At the same time, the lyrics ignore the book of Corinthians, which tells how important it is to give up being childish. You need to lie to get by sometimes, although Agent J has trouble telling just where and when to stop lying. Much of MIB 3 is about the conflict over telling the truth and lying.

Come to think of it, that conflict could be much of what life is about.

Agent J after finally telling young Agent K that Boris the Animal will kill him when he goes to Florida to stop Boris, and that’s what Agent J wants to prevent: “I know I told you everything but…”

Young Agent K punches him in the nose: “That’s for lying to me! He punches Agent J again and says, “And that’s for telling me the truth!”

The Patsy Cline song is about seeing all of the good and none of the bad, all of the right and none of the wrong—and how wonderful that would be. Could it be ironic? On the other hand, in the real world of grownups, maybe Griffin has the idea:

Griffin: “The bitterest truth is better than the sweetest lie.” Well, sometimes.

Christmas Cactus Flower in the Spring!

Our Zygocactus flower or Christmas Cactus didn’t bloom this past winter. But a plucky little flower has been poking out its head in the past few days.

It’s a symbol of hope in the desert of our times.

Whitetail Deer Think Your Lawn is a Salad Bar

We have a small herd of whitetail deer who regularly visit our lawn because they think it’s a salad bar. They’re all over the neighborhood because the city apparently doesn’t have a consistent deer population management plan. I don’t know anything about the animals, other than what I care to look up on the internet.

We saw several bucks the yesterday. One of them was missing an antler. It might have been lost in a fight with another buck.

As far as we could tell, most of the deer seemed pretty healthy, although I guess you can’t really tell which ones might have chronic wasting disease just by looking at them.

One animal looked like it might have suffered an injury, possibly from a buck. The lesions looked like they might be healing.

I guess this time of year, they would be molting. That probably explains why some of them look scraggly.

Sena taps on the windows and orders them off the property. That doesn’t work. Sometimes they look up at you like they know you’re staring at them—but they usually ignore you and go back to munching on your lawn.

I wonder if I’d feel differently about culling the whitetail deer if I watched hunters actually cull them—or kill them. The word “culling” actually sounds like a nicer version of “killing.” The definition of culling is the reduction in the population of wild animals by “selective slaughtering.”

The origin of the word “cull” is interesting. It comes from the Latin verb colligere, meaning “to gather.” In general, it means to collect a group of animals into separate groups: one to keep and one to kill. Usually, it’s about killing the weak and sick ones.

On the other hand, the origin of the word “kill” seems to be obscure. Of course, it means to strike, hit, put to death. It might derive from an Old English word, “cwellan,” which means to murder, or execute.

Cwellan, cull, kill. I think it’s a coincidence they sound similar. None of them sound like “Bambi.” When me and my brother were little, we had a toy record player that played a simplified version of the Disney classic movie, Bambi. It had either a little storybook that came with it or a little slide show. It got a lot of use. One slide showed a shadowy image of a big stag. Eventually the record got stuck on a place that cried over and over, “Man!”

Maybe that’s why the city doesn’t have a whitetail deer culling plan.

“Stink, Stank, Stunk!”

I’m just puzzled lately over what seems like a contradiction between two ideas I’ve seen in the news and in TV commercials. It’s all about body odor.

There is this study that was recently published about stinky armpit odor possibly making the practice of mindfulness meditation more effective.

This contrasts with the usual meaning of body odor, which is that it’s to be avoided and prevented at all costs. And, the newest total body odor eliminator product is getting heavy rotation in TV commercials and its name rhymes, (possibly fittingly) with “looney.” I’m just going to frankly admit that I can’t stand watching the commercial.

There is this old timer product called Ex-Odor that was marketed in the early 1900s by a company called Gordon Gordon, Ltd. The label said it “Removes All Body Odors.” It was touted as “safe, sure, lasting” and it cost only ten cents. The original label actually did italicize the word “All.” On the other hand, Looney is a lot more expensive—just sayin’.

The armpit odor study and Looney definitely send opposite messages about body odor.

In fact, there is a psychiatric disorder marked by an intense preoccupation with smelling bad. I think it’s still called Olfactory Reference Disorder (ORD). Almost any part of the body could stink and could lead to showering several times a day or visits to ENT doctors to get “infected” and therefore smelly tonsils removed. The disorder not uncommonly gets requests for consultation-liaison psychiatrists to get involved.

Olfactory Reference Disorder can lead to severe, even disabling, social anxiety. It can lead to beliefs that have delusional intensity.

Often, those with ORD firmly believe they emit a foul odor, often from armpits, or inguinal, anal, and oral areas. Some seek surgical treatment. There are many other disorders which consultation-liaison psychiatrists need to remember in order to distinguish ORD from them. Combined cognitive behavioral therapy, possibly along with medication can be recommended as treatment.

Hello, I’m Dr. James Caramel Brown

I read Dr. Moffic’s article, “The United States Psychiatric Association: Social Psychiatric Prediction #4”. I think the rationale for renaming the American Psychiatric Association makes sense.

However, it also got me thinking about the names of other associations connected to the APA (here meaning American Psychiatric Association). One of them is the Black Psychiatrists of America, Inc. We make up about 2% of psychiatrists in the United States.

It also reminded me to once again do a web search for the term “Black psychiatrists in Iowa.” It turns out the results would lead to a repeat of my previous post “Black Psychiatrists in Iowa” on May 7, 2019. Nothing has changed. My colleague Dr. Donald Black, MD is still coming up in the search. Just as a reminder, he’s not black.

It probably comes as no surprise to readers of my blog that this also reminds me of a couple of Men in Black scenes.

Video of Men in Black scene, Dr. Black and Dr. White quotes.

And my post still appears high up in the list of web sites. There has also not been published a more recent edition of the Greater Iowa African American Resource Guide than the one in 2019. You can still find my name and that of Dr. Rodney J. Dean listed in the 2019 edition as the only black psychiatrists in Iowa.

In case you haven’t noticed, I’m retired. I have never considered changing my name and title to Dr. James Caramel Brown. If you noticed that the “Caramel Brown” part is from Men in Black 3 (Agent J talking about what Agent K should say about his skin color in his eulogy for him), give yourself a pat on the back.

Agent J: Can you promise me something, if I go first, you’ll do better than that at my funeral? Yeah, something like, uh: “J was a friend. Now there’s a big part of me that’s gone. Oh, J, all the things I should have said, except I was too old and craggy and surly and just tight. I was too tight. Now, I’m gonna just miss your caramel-brown skin.”

Agent K: I’ll wing something.

Anyway, I’m not sure what to do about renaming the American Psychiatric Association. But I think whoever is in charge of google search results for the term “black psychiatrists in Iowa” could improve on the current situation.

Feisty and So On

There’s this dialogue in Men in Black II between Serleena and Zed:

Serleena: Zed, look at you, 25 years and you’re still just such a looker.

Zed: Cut out the meat dairy. And you, still a pile of squirmy crap in a different wrapper.

Serleena: So feisty.

I’m becoming more aware of the use of the word “feisty” in reference to so-called “older” persons. That’s because I’m getting older.

I noticed an article on the use of patronizing words for older persons. A couple of other such words are “spry” and “sharp.”

“Sharp” as in sharp as a tack (for his age, of course). Also, as in sharp enough to know today’s date.

“Spry” as in he is spry enough to get into and out of a chair.

I’m also spry enough on most days to do under the leg and behind the back juggling tricks.

I’m still sharp enough to know the difference between respectful and patronizing.

I guess that makes me feisty.

Random Connections

Today, I read Dr. George Dawson’s blog post, “How I ended up in a high-risk pancreatic cancer risk screening clinic.” As usual I was impressed with his erudition, scientific literacy, and rigorous objectivity, even as it pertained to a deadly disease which runs in his family genetic history. I couldn’t help admiring his courage.

And, whether this is a random connection or not, this somehow led to my remembering Dr. George Winokur, a giant in the scientific study (including genetics) of psychiatric diseases, especially mood disorders. He died of pancreatic cancer shortly after he was diagnosed with it in the spring of 1996.

Dr. Winokur was chair of the University of Iowa Department of Psychiatry from 1971 to 1990. He remained on faculty, actively involved in research and teaching up until the day of his death in October of 1996.

I was a resident in psychiatry at University of Iowa from 1992-1996 and I have a clear recollection of meeting with Dr. Winokur in his office during my last year, when I was preparing for job interviews. I knew he had been diagnosed with pancreatic cancer.

He had been actively recruiting me to accept a position in the department and did so even as we spoke briefly. I remember noticing that he gripped an electrical conduit on the wall next to his desk so tightly that I wondered if he were in pain.

He was the main reason I stayed in Iowa. He had a great sense of humor. All of us residents loved him. There was even a list of his “commandments” all new residents received when they began their residencies at Iowa.

Winokur’s 10 Commandments

Thou shalt not sleep with any UI Psychiatry Hospital patient unless it be thy spouse.
Thou shalt not accept recompense for patient care in this center outside thy salary.
Thou shalt be on time for conferences and meetings.
Thou shalt act toward the staff attending with courtesy.
Thou shalt write progress notes even if no progress has been made.
Thou shalt be prompt and on time with thy letters, admissions and discharge notes.
Thou shalt not moonlight without permission under threat of excommunication.
Data is thy God. No graven images will be accepted in its place.
Thou shalt speak thy mind.
Thou shalt comport thyself with modesty, not omniscience.

I never got the impression that George Winokur recruited me because I was black, although it was pretty obvious to me that I would be the first black University of Iowa psychiatry department faculty member. He had too much class to make that an issue.

I’ve known a few classy psychiatrists. Maybe the connection is not so random.

Exactly When Were the Good Old Days?

I just saw a short web article about Baby Boomers and their opinion of what’s going on these days and comparing it to the “good old days.”

There were the usual complaints about bad music, lack of teamwork, no effort to maintain social bonds, and the like.

I’m not sure I can identify any such good old days. I can think of good and bad times. I tend to think of them as being a byproduct of good experiences with people you enjoy being with—which don’t always fit with the times.

I grew up in the 1960s during the Civil Rights struggle, and I would be hard-pressed to call it the good old days. I can recall my mother trying her best to straighten out the curls of the hair of my younger brother and me with a lot of hair oil. It was almost painful as she tried to press the evidence of our mixed white and black parentage out of our hair.

I think the perception of what the good old days were might depend on your place in society at the time.

There’s this old Twilight Zone episode about a guy trying to make it in the tough business world and he wasn’t doing too well.

Spoiler Alert: I reveal what happens in the ending, just in case you want to try to find a YouTube.

On the train home from the office, he would dream of a place called Willoughby. It was a place years before his time. It was sunny. People were friendly, enjoyed picnics, went fishing and it was always summertime. He longed for it. His boss was a tyrant and his wife pretty much called him a failure. He got off the train at the Willoughby stop a few times and really enjoyed the good old days feel to the place. But he always got back on the train.

One day, he had that “last straw” moment. His boss was tyrannical; his wife belittled him and called him a loser. He got off the train at Willoughby, determined to stay in the good old days.

OK, this is the spoiler:

Willoughby turns out to be the name of the undertakers who pick him up where he jumped off the train and died.

Anyway, this “train” of thought led to Sena and I reminiscing about the trip to Hawaii we made way back in the day. The flight was long and excruciating. My ears were plugged most of the way there. We were both exhausted, but the tour group we traveled with were raring to go after we got to the hotel in Waikiki. They were mostly 3 decades older than us. I can’t remember if one of them or somebody else at the airport made a disparaging comment about Waikiki, something like: “I don’t know why anybody thinks Waikiki is anything special; what the hell, it’s just like Des Moines!”

While we camped out in our hotel room, the older folks went out to see Don Ho perform. When they got back, they said Don was drunk, they had a few drinks, and we just marveled at their energy.

We developed a friendship with a married couple in the tour group named Leota (Lee for short) and Norman. Lee took exception to Norman having a beer with the rest of us on some outing. I think it was about a health problem he had. He grumbled a little and we toasted the event anyway. Norman, who had been in the military, shed a few tears at the Pearl Harbor monument.

We traded Christmas cards with Lee and Norman until their children sent us a card telling us that Lee had died. Norman died several years later. We still have a photo of Sena with Lee and Norman taken while we were having a great time in Hawaii.

I guess you call those the good old days. Maybe you could even find a reason to call the present times the good old days after a while—if you were as drunk as Don Ho during the whole era.

Fathers Can Be a Pain in the Ass

I’m going to talk a little bit about fathers. Mothers are important too, but I’m a guy and I can talk about mothers another day. Because it’s a touchy subject, I’m going to begin with a Men in Black (MIB) joke, like I always do when I’m being defensive. There’s this MIB 3 scene in which Agent K and Agent J have this exchange:

Agent K: I used to play a game with my dad, what would you have for your last meal. You could do worse than this (explanation for this: they’re sitting in a restaurant and an eyeball in Agent K’s soup swivels around and stares at him).

Agent J: Oh, okay, I used to play a game with my dad called catch. Except I would throw the ball and it would just hit the wall, cause—he wasn’t there.

Agent K: Don’t bad mouth your old man.

Agent J: I’m not bad mouthing him, I just didn’t really know him.

Agent K: That’s not right.

Agent J: You’re damn right, it’s not right. A little boy needs a father.

On one level, this scene is just another way of showing the father/son, teacher/student, mentor/mentee relationship Agents K and J had with each other. By extension, their interaction says something about what happens in similar real-life relationships—in the shallow, cliché ways that movies always do.

I sometimes think about the relationship I had with learners when I was a teaching consultation-liaison (C-L) psychiatry. Often, I say to myself that I never had a mentor and I was never a mentor.

That’s not true. Although I never had a mentor who was formally assigned to me, there was more than one faculty member in the psychiatry department with whom I had an informal mentor/mentee relationship. And I was an informal mentor to at least a few trainees.

However, I was middle-aged by the time I entered medical school, which probably set the stage for awkward relationships with my fellow students and some teachers, partly because I was either the same age as or older than them.

That doesn’t mean I was wiser than them. It just means that I was conflicted about them. Later, in residency, I learned about transference and countertransference. In fact, I focused on the psychodynamic as well as the medical issues in teaching trainees. In the first C-L manual I wrote (the forerunner to the book I and my co-editor published later), I devoted a large section to psychodynamic factors relevant to doctor-patient relationships.

So, if you’re wondering when I’m going to start bad-mouthing my old man, you can stop wondering. I’m not going there. He wasn’t a hero, like Agent J’s father was (you need to see the movie to get this angle).

My dad was funny. I don’t think I got my own sense of humor from him, but it makes sense why I would have one—and just because “he wasn’t there” doesn’t explain everything. It never does.

Fathers can be a pain in the ass, not just because of dad jokes. Fathers can be a pain in the brain, too. Ask anybody who was a latchkey kid; I was one of those. We really don’t belong to any specific generation.

We also can’t just up and time travel like Agent J and find out about the father we never really knew. Mostly, it’s just bits and pieces, like a matchbook with a name and address from somebody on your paper route. The path it can lead to doesn’t always mean you find out that “Your daddy was a hero,” like a young Agent K tells young James (who becomes Agent J in the future) after he neuralyzes him to shield him from the hard truth about his father.

You’ll have to watch the movie to get that one.

More On Taming the Juggling Balls

I’ve been juggling for about 5 months now and reflecting on my progress. I think I’m doing OK for a geezer. Sena would call me a hot dog although I would still call it ugly juggling by any standard.

What’s striking, at least to me, is the little bit of science I can find on the web about juggling. I hear the term “muscle memory” when it comes to learning juggling. Actually, there’s some truth to that. There are different kinds of memory. For example, most of us know about declarative memory, which about memorizing facts, because we use it to prepare for exams. Those of us who went to medical school remember the agony of taking tests for the basic sciences.

But so-called muscle memory, or the memory for learning new skills like juggling, takes place in the brain. There was a study published in 2009 which found changes in both gray and white matter of subjects before and after learning to juggle (Scholz J, Klein MC, Behrens TE, Johansen-Berg H. Training induces changes in white-matter architecture. Nat Neurosci. 2009;12(11):1370-1371. doi:10.1038/nn.2412).

The study about correlation of the inability to stand on one leg for 10 seconds with higher mortality in older patients, which I relate to the ability to do the under the leg juggling trick, was published last year (Araujo CG, de Souza e Silva CG, Laukkanen JA, et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. British Journal of Sports Medicine 2022; 56:975-980.)

I talk a lot about juggling as though I’m a teacher. I’m not a juggling instructor by any means. You can find better juggling teachers on the web. But my approach to talking about juggling in terms of it being a hobby for me is really not different from how I talked about consultation-liaison psychiatry before and after I retired. I’m still a teacher—just evolving in retirement.